The Press Ganey® Medical Practice Survey ("Press Ganey® survey") is a patient-reported questionnaire commonly used to measure patient satisfaction with outpatient health care in the United States. ...Our objective was to evaluate the reliability and validity of the Press Ganey® survey in a single institution setting.
We analyzed surveys from 34,503 unique respondents seen by 624 providers from 47 specialties and 94 clinics at the University of Utah in 2013. The University of Utah is a health care system that provides primary through tertiary care for over 200 medical specialties. Surveys were administered online. The Press Ganey® survey consisted of 24 items organized into 6 scales: Access (4 items), Moving Through the Visit (2), Nurse Assistant (2), Care Provider (10), Personal Issues (4) and Overall Assessment (2). Missingness, ceiling and floor rates were summarized. Cronbach's alpha was used to evaluate internal consistency reliability. Confirmatory factor analysis was used to assess convergent and discriminant validities.
Missingness was 0.01% for the total score and ranged from 0.8 to 11.4% across items. The ceiling rate was high at 29.3% for the total score, and ranged from 55.4 to 84.1% across items. Floor rates were 0.01% for the total score, and ranged from 0.1 to 2.1% across items. Internal consistency reliability ranged from 0.79 to 0.96, and item-scale correlations ranged from 0.49 to 0.9. Confirmatory factor analysis supported convergent and discriminant validities.
The Press Ganey® survey demonstrated suitable psychometric properties for most metrics. However, the high ceiling rate can have a notable impact on quarterly percentile scores within our institution. Multi-institutional studies of the Press Ganey® survey are needed to inform administrative decision making and institution reimbursement decisions based on this survey.
► We examined effects of manipulations of on-package graphics design. ► Participants preferred rounded and upward-oriented shapes. ► Shape preference could not be attributed to the effects of ...typicality. ► Orientation preference appeared congruent with product characteristics. ► Participants preferred label designs that placed graphics to the right of text.
On-package graphics have the potential to influence consumers’ product-related attitudes and behaviours. In the reported study graphics designs on the labels of two products (water and vodka) were manipulated with respect to shape angularity, orientation, and left–right alignment. Participants’ evaluations indicated a preference for rounded shapes that could not be accounted for by differences in design typicality; and preference for upward shape orientation. An interaction between these response variables for ratings of purchase likelihood suggested that congruence between graphical and product form (droplet shape) may be advantageous. Effects of alignment were not consistent with existing theories, with right-aligned graphics being preferred. An explanation that distinguishes processing efficiency and hemispheric efficiency is proposed. Finally, as predicted, a halo effect was apparent, such that effects of aesthetic manipulations extended to ratings of product attributes that were not experienced. Theoretical and practical implications of these results are discussed.
Objectives
To develop and assess the reliability and validity of composite measures of reasons for disenrollment from Medicare Advantage (MA) and prescription drug plans (PDPs).
Data Source
Medicare ...beneficiaries who responded to the Medicare Advantage and Prescription Drug Plan Disenrollment Reasons Survey.
Study Design
Separate multilevel factor analyses of MA and PDP data suggested groupings of survey items to form composite measures, for which internal consistency and interunit reliability were estimated. The association of each composite with an overall plan rating was examined to evaluate criterion validity.
Principal Findings
Five composites were identified: financial reasons for disenrollment; problems with prescription drug benefits and coverage; problems getting information and help from the plan; problems getting needed care, coverage, and cost information; and problems with coverage of doctors and hospitals. Beneficiary‐level internal consistency reliability exceeded 0.70 for all but one composite (financial reasons); plan‐level internal consistency reliability exceeded 0.80 for all composites; average interunit reliability for plans with ≥ 30 survey completes exceeded 0.75 for 3 of 5 composites. As expected, greater endorsement of reasons for disenrollment was associated with lower overall plan ratings.
Conclusions
The Disenrollment Reasons Survey provides a reliable and valid assessment of beneficiaries' reasons for leaving their plans. Multiple reasons for disenrollment may indicate especially poor experiences.
Objective. Consumer assessments of health care provide important information about how well health plans and clinicians meet the needs of the people they serve. The purpose of this study was to ...examine whether consumer reports and ratings of care in Medicaid managed care vary by race/ethnicity and language.
Data Sources. Data were derived from the National CAHPS® Benchmarking Database (NCBD) 3.0 and consisted of 49,327 adults enrolled in Medicaid managed care plans in 14 states in 2000.
Data Collection. The CAHPS® data were collected by telephone and mail. Surveys were administered in Spanish and English. The response rate across plans was 38 percent.
Study Design Data were analyzed using linear regression models. The dependent variables were CAHPS® 2.0 global rating items (personal doctor, specialist, health care, health plan) and multi‐item reports of care (getting needed care, timeliness of care, provider communication, staff helpfulness, plan service). The independent variables were race/ethnicity, language spoken at home (English, Spanish, Other), and survey language (English or Spanish). Survey respondents were assigned to one of nine racial/ethnic categories based on Hispanic ethnicity and race: White, Hispanic/Latino, Black/African American, Asian/Pacific Islanders, American Indian/Alaskan native, American Indian/White, Black/White, Other Multiracial, Other Race/Ethnicity. Whites, Asians, and Hispanics were further classified into language subgroups based on the survey language and based on the language primarily spoken at home. Covariates included gender, age, education, and self‐rated health.
Principal Findings. Racial/ethnic and linguistic minorities tended to report worse care than did whites. Linguistic minorities reported worse care than did racial and ethnic minorities.
Conclusions This study suggests that racial and ethnic minorities and persons with limited English proficiency face barriers to care, despite Medicaid‐enabled financial access. Health care organizations should address the observed disparities in access to care for racial/ethnic and linguistic minorities as part of their quality improvement efforts.
Objective. To estimate the reliability and validity of survey measures used to evaluate health plans and providers from the consumer's perspective.
Data Sources. Members (166,074) of 306 U.S. health ...plans obtained from the National CAHPS® Benchmarking Database 2.0, a voluntary effort in which sponsors of CAHPS® surveys contribute data to a common repository.
Study Design. Members of privately insured health plans serving public and private employers across the United States were surveyed by mail and telephone. Interitem correlations and correlations of items with the composite scores were estimated. Plan‐level and internal consistency reliability are estimated. Multivariate associations of composite measures with global ratings are also examined to assess construct validity. Confirmatory factor analysis is used to examine the factor structure of the measure.
Findings. Plan‐level reliability of all CAHPS® 2.0 reporting composites is high with the given sample sizes. Fewer than 170 responses per plan would achieve plan‐level reliability of .70 for the five composites. Two of the composites display high internal consistency (Cronbach's alpha >=.75), while responses to items in the other three composites were not as internally consistent (Cronbach's alpha from .58 to .62). A five‐factor model representing the CAHPS® 2.0 composites fits the data better than alternative two‐ and three‐factor models.
Conclusion. Two of the five CAHPS® 2.0 reporting composites have high internal consistency and plan‐level reliability. The other three summary measures were reliable at the plan level and approach acceptable levels of internal consistency. Some of the items that form the CAHPS® 2.0 adult core survey, such as the measure of waiting times in the doctor's office, could be improved. The five‐dimension model of consumer assessments best fits the data among the privately insured; therefore, consumer reports using CAHPS® surveys should provide feedback using five composites.
OBJECTIVE: To examine the extent to which racial/ethnic differences in Consumer Assessment of Health Plans Study (CAHPS) ratings and reports of Medicaid managed care can be attributed to ...differential treatment by the same health plans (within‐plan differences) as opposed to racial/ethnic minorities being disproportionately enrolled in plans with lower quality of care (between‐plan differences).
DESIGN: Data are from the National CAHPS Benchmarking Database (NCBD) 3.0. Data were analyzed using linear regression models to determine the overall effects, within‐plan effects, and between‐plan effects of race/ethnicity and language on patient assessments of care. Standard errors were adjusted for nonresponse weights and the clustered nature of the data.
PATIENTS/PARTICIPANTS: A total of 49,327 adults enrolled in Medicaid managed care plans in 14 states from 1999 to 2000.
MAIN RESULTS: Non‐English speakers reported worse experiences compared to those of whites, while Asian non‐English speakers had the lowest scores for most reports and ratings of care. An analysis of between‐plan effects showed that African Americans, Hispanic‐Spanish speakers, American Indian/Whites, and White‐Other language were more likely than White‐English speakers to be clustered in worse plans as rated by consumers. However, the majority of the observed racial/ethnic differences in CAHPS reports and ratings of care are attributable to within‐plan effects. The ratio of between to within variance of racial/ethnic effects ranged from 0.07 (provider communication) to 0.42 (health plan rating).
CONCLUSIONS: The observed racial/ethnic differences in CAHPS ratings and reports of care are more a result of different experiences with care for people enrolled in the same plans than a result of racial/ethnic minorities being enrolled in plans with worse experiences. Health care organizations should engage in quality improvement activities to address the observed racial/ethnic disparities in assessments of care.
This study examined whether health confidence is associated with consumers' ratings and reports of care and whether adjusting for health confidence and other factors attenuates ethnic or racial ...disparities. Data are from the 2005 Medical Expenditure Panel Survey. Persons with greater health confidence had lower adjusted odds of high overall care ratings (OCRs) and high reports of getting needed care and provider communication. Adjusting for health confidence and other factors, there were no Hispanic/non-Hispanic differences. Compared with whites, African Americans had lower OCRs and reports of getting needed care; Asians had lower OCRs and reports of getting needed care, getting care quickly, and provider communication. Health care organizations and providers should consider targeting improvement efforts toward health-confident persons and adjusting for health confidence when comparing consumer assessments across groups. Although health confidence is associated with consumer assessments, other factors explain racial and ethnic differences.
This article reports on the work of the New York State Office of Mental Health Downstate Alliance, which is comprised of eight psychiatric centers that have formed a consortium to create new ...initiatives and solve common problems. The first of these initiatives are the inpatient and outpatient versions of the Consumer Assessments of Care, which assess satisfaction with care and quality of life (QOL). Consumers from peer run organizations who administered the survey used a mixed-mode administration method, which leveraged the strengths of the personal interview and anonymous self-report methods. Inpatients reported realistic levels of satisfaction and showed areas for improvement for inpatient units across facilities. Outpatients were considerably more satisfied with care, but ratings were lower on the work and community involvement dimensions of QOL. Factor analyses indicated that a one-factor model, satisfaction with care, fit the data well for the inpatient survey. A two-factor solution, satisfaction with care and QOL, was successfully fit to the outpatient data. Internal consistency reliability levels were excellent for both assessments.
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